Tests, Treatments & Therapies for Anal Cancer

At the University of Colorado Cancer Center, we use the most minimally invasive approach possible for both diagnosis and treatment of anal cancer. We recognize that both work-up and management requires a multidisciplinary approach with numerous specialists working closely together.

We use both standard treatments and those being tested in clinical trials. You might consider participating in a trial, which are designed to improve current treatments or get information on new treatments. If a new treatment is proven better than the standard treatment, the new treatment may become the standard treatment.

Staging and Detection Tests

Once a cancer has been diagnosed, it is very important for doctors to find out where the cancer may have spread (the “stage” of the cancer) to determine the best possible treatment plan for you. To find out, doctors use staging tests, which include:

• Different types of scans
• Different ways to take tissue samples to look for tumor cells microscopically (biopsy tests)

Scans and other tests may also be used:

• In a “surveillance program” looking for any signs of relapse after treatment
• In a “screening program” to detect cancer early in individuals at high-risk
• To monitor responses to treatment

Tests that may be used include:

Anoscopy – An exam of the anus and lower rectum using a short, lighted tube called an anoscope.

Biopsy – The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

Digital rectal exam – The doctor or nurse inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or anything else that seems unusual.

Proctoscopy – An exam of the rectum using a short, lighted tube called a proctoscope.

Types of scans include:

CT scan (computed tomography) – An X-ray procedure that creates detailed, highly accurate cross-sectional body images.

Endo-anal or endorectal ultasound – An ultrasound transducer (probe) is inserted into the anus or rectum and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

PET scan (positron emission tomography) – An imaging test used to light up cancer in different parts of the body. You get an injection of a short-lived radioactive substance before having the scan. Cancerous tissue will build up more of the substance and appear brighter than normal tissue on the PET images. Other non-cancerous tissues, such as areas of inflammation, can also sometimes “light up.”

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Treatment & Therapy for Anal Cancers

Anal cancer is one of the few cancers in which a combination of radiation and chemotherapy can cure the majority of patients (depending on the cancer stage) without surgery.

Radiation Therapy (“Radiotherapy”):

Radiation therapy involves using X-rays and other types of medical radiation aimed at specific parts of the body to:

• Kill cancer cells
• Prevent cancer cells from developing or recurring
• Improve many of the symptoms caused by cancer

Radiation therapy can be:

• Used before surgery to make the operation easier (this is called “neoadjuvant” treatment)
• Used after surgery to reduce the chances of the cancer coming back (this is called “adjuvant treatment”)
• Almost as effective as surgery in people who are not fit enough for an operation
• Better than surgery when used together with chemotherapy for certain cancers (this is called “chemo-radiotherapy”)

Chemotherapy and other drug-based treatments:

Anti-cancer drug treatments – Chemotherapy-and new “targeted therapies”-involve using drugs that kill, slow down or damage cancer cells. Many new drugs are being developed. View current anal cancer clinical trials available at UCCC.

Anti-cancer drug treatments may involve:

• Single drugs or combinations of drugs
• Intravenous injections or tablets/capsules
• Taking the drugs in repeating patterns, called “cycles”, that usually last three to four weeks
• Taking some drugs every day or only on a few days within the cycles
• Taking other medicines to reduce or eliminate side effects associated with chemotherapy
• Taking targeted therapies, often with very little side effects, on their own or in combination with standard chemotherapy
• Access to new drugs or vaccines on their own, or added into standard treatments, in clinical trials

Chemotherapy and targeted therapies can:

• Be given before surgery to make the operation easier
• Be given in combination with radiotherapy to make both treatments more effective
• Be given after surgery to reduce the chances of cancer coming back
• Successfully control advanced cancer and many cancer-related symptoms

Surgery

Usually anal cancers respond very well to chemotherapy and radiation. Some cancers, however, can recur or persist. In this setting surgery becomes important for removing all the disease. A surgical oncologist-a doctor who specializes in cancer operations-will perform the operation.

Local excision – If the cancer is found at a very early stage, it can be removed without cutting into the abdomen.

Abdominoperineal resection – The anus, the rectum and part of the sigmoid colon are removed through an incision made in the abdomen. The doctor sews the end of the intestine to an opening made in the surface of the abdomen so body waste can be collected in a disposable bag outside of the body. Lymph nodes that contain cancer may also be removed during this operation.

Anal cancer surgery with colostomy – The anus, rectum and part of the colon are removed, a stoma is created, and a colostomy bag is attached.

Groin dissection – If after chemotherapy or radiation, cancer is found in the lymph nodes of the groins, the cancerous lymph nodes are surgically removed.

Clinical Trials

The goal of clinical research is to improve treatment outcomes and reduce treatment side effects or long-term toxicities. Clinical trials provide the latest treatments because they evaluate:

• New drugs
• New combinations of therapies
• New treatment delivery methods

Because we’re the Rocky Mountain region's only National Cancer Institute (NCI)-designated Comprehensive Cancer Center-one of only 39 in the United States-your treatment will always include the latest and most comprehensive care options.

Learn more about clinical trials at UCCC.